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Friday, April 24, 2015

Five Big Ideas from the World Health Care Congress #WHCC15

I had the good fortune to attend the World Health CareCongress. The event pulls together some of the most respected leaders in
healthcare and shares the issues of the day from diverse perspectives. I walked
away with pages and pages of tweets and notes. Way too much to summarize
session by session. I decided to let it sit for a while and then come back
to it and share the ideas I continue to think about.

Beyond the obvious reasons to care about patient safety, the avoidance of complications has much more impact than price on the overall cost of care.

There were a number of interesting tidbits from the
Patients Take the Wheel study conducted by Trinity Health. In the same way people
don't trust congress, but like their representative consumers lack confidence
in the healthcare system, but trust their doctors. Millennials in particular
are willing to change behavior to get affordable care. 54% of millennials will
delay or avoid getting care because of the cost. Young consumers want
convenience. They will travel an extra 30 minutes to receive care where the lab,
x-ray and provider are all in one place. Many patients feel their doctors spend
too much time looking at a computer and entering data during their visits. Millennials are embracing retail access to care -- 34% of millennials visited a
retail clinic last year. Few people are presently negotiating what they pay for
care, but it's expected to become a trend. Do you
think Wal-Mart
will become the biggest provider of care in the next five years?

A geriatric study revealed patients aged 65-93 are excited to
use technology for healthcare according to Dr. Bloomfield at Duke Medicine. I’m
a firm believe that assuming Millenials are driving all the desire for new
technology and communication platforms will lead you astray. Interestingly,
I’ve never seen a definition of an engaged healthcare consumer, so I’m working
on developing one. People obviously need the right support to engage as
consumers, but I think it also helps to be clear about what we’re asking
people to do. I’d be grateful if you would share
your thoughts.

More
than one person recommended watching The Emperor of All Maladies a
PBS documentary that illustrates the decision making process consumers go through
when faced with a cancer diagnosis.

Two: The Data is a Mess, but the Vision of What's to Come is Powerful

Image from recapo.com

The value of bringing payor and provider data together is immense when it comes to managing risk. There was lots of talk about electronic medical records. I was chatting with a hospital system medical director that said they used 11 different versions of Epic within their system and nothing was integrated. There was some discussion of when data collection becomes research and requires informed consent. For the most part though, that's not a big concern expressed by consumers. People are willing to share their information if it allows them to learn something useful in return. People are much more concerned about the security of their financial data than their health data. Younger people in particular express little concern. It's a small percentage of the population that cares, but they care deeply.

Everyone agrees that we have to identify and differentiate the people that need care the most and help them through the fragmented system. Imagine ordering a heart health kit or a diabetes health kit on Amazon. It would include everything you need to monitor your health conditions. All the data you capture would be visible on your iPhone and integrated into a dashboard that your physician views daily. The physician looks for outliers -- people whose blood pressure or blood sugar is trending outside acceptable norms -- then, the physician reaches out to these individuals.

Three: Employers
are Driving Change

Image from engadget.com

The 80% of the population that is healthy may shop for
care, but they only incur 20% of the cost. The critically ill don't shop for
care. Therefore, you must incentivize doctors to carefully consider where they
refer. Boeing seems to have accomplished this by creating its own ACO with Providence-Swedish
Alliance.

The providers in the ACO have an incentive to
effectively manage the cost of care and they consider the cost when they may
referrals. Providence-Swedish reported that they're making progress by focusing
on just the data points needed to take action on what is learned. (The small
ball approach to data integration.) Consolidation in the marketplace creates a
challenge for employers that just want to include top quality hospitals. You
can't pick and choose, you have to include all the hospitals in a system.
Consolidation is also worrisome because it's competition that drives down
costs.

Twitter lit up when we heard from Harris Rosen from Rosen
Hotels about their
involvement in the delivery of care. Whereas
other hotel companies have a lot of turnover, Rosen says his company has single
digit turnover. He credits the health plan. When Rosen employees visit the
health clinic, they're on the clock. They'll even be given a ride if they need
it. It's
so successful, he's contemplating building his own hospital. He shared his
vision of a hospital that is a healing environment with 24/7 room service and
murphy beds in all the rooms for family members. Think about how bringing
hospitality to medicine could change the experience.

Gary
Loveman from Caesars Palace closed the first day of the conference with a
rousing talk about their wellness initiatives. He said that you overcome
resistance with incentives, information, encouragement, choice and convenience.
He mentioned his concern about the EEOC challenges to wellness programs. The
actions necessary to qualify for an incentive can't become so trivial that they
don't have an impact. He related the concern to financial management. What if an
employer could attest to do the right thing and then face stiff penalties if
they don't? Caesars is beginning to experiment with bundled payments for things
like knee replacements. You can't argue that the casino industry knows how to create consumer engagement. It's nice to hear that they're using this knowledge to help people improve their health.

Four: No
Employers Plan to Pay the Cadillac Tax Putting an End to the Open Bar

Image from johnlund.com

The Cadillac Tax was referred to frequently as the tax
that no one will pay. Employers are devising what Jeffrey Shapiro from Disney
referred to as a glide path to 2018 and planning to limbo under the tax. Higher
deductibles are one of the main strategies being employed, but there are also a
lot of efforts to decrease the demand for care by keeping people healthy.
Nobody on either side of the table thinks the ACA will be appealed. Tweaked
maybe, but the horse is too far out of the barn. Union Pacific delivers incentives via payroll rather than
through an HSA. You can see how this could become a common practice with the
Cadillac Tax hits. Employers
have also taken note that employee behavior changes once employees meet their
deductible. If there is no coinsurance, it becomes an open bar.

Five: Telemedicine
Could be a Real Game Changer in Behavioral Health

Image from rachaellelynn.com

A session presented by Henry DePhillips, MD from
Teladoc was packed and people asked tons of questions. Teladoc claims that two-thirds of ER visits
could be handled virtually. He said 85% of people in emergency rooms just couldn't wait to see their primary care provider.On average, it takes 18.5 days to get an appointment with a new primary care doctor. 50% of Teladoc users don’t have a primary care doctor. Teladoc is
also popular with people who need care when they’re traveling. You have
to talk with a doctor licensed in the state you are calling from in telemed, so
building the network is complicated. The doctors get paid per consult. Teladoc
charges patients $40 per consult and the doctors earn between $23 and $28 per
consult. Did you know you don't just rate Uber drivers, they rate you as a
customer? Teladoc does the same thing. They offer both phone and
video consultations, but 85% of patients choose a phone consultation. Now for
what I think is a real game changer – Teladoc is adding a whole behavioral
health component. Think about how that could break down the barriers people
face to get care.With a little luck, I'll be at #WHCC16. Hope to see you there!